A Guide to Getting Test Results From Your Doctor

During a months-long quest to resolve unexplained fatigue and joint pain, Rachel Horner took more than a dozen blood tests. To get test results, she typically had to schedule in-person appointments. Some weeks, she trudged into multiple doctors’ offices just to hear that her blood work had come back normal.

“After any request for a test or blood work, they make me schedule a follow-up before I leave the office,” says Horner, who lives in Los Angeles. “Thankfully my work is understanding, but I don’t understand why I can’t just get a phone call.”

Waiting for the results of any medical test, whether it’s routine blood work, a pregnancy test or a biopsy, can be a stressful experience. Some doctors call, text or email patients with results, while others require in-person visits. No federal or state law dictates how or when doctors share test results with patients — legally, both approaches are fine.

“Ultimately, it’s the patient’s information, and it should be accessible to them.”

“Patient-provider communications are largely unregulated,” says Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation. So, in effect, providers, practices and hospitals determine their own policies.

Most providers who require follow-up visits to share test results have a reason for doing so, Donovan says, and aren’t just trying to bill extra time: “They may want to be able to deliver bad news in a controlled environment where they can also discuss a treatment plan.”

That doesn’t mean patients have to get on the same page. If you want to get results by phone or email, it’s within your rights to ask. But before you speak up, make sure you understand what doctors need to consider, and what patients are owed, when it comes to communicating medical news.

What your doctor is thinking

For years, Dr. Dennis Gingrich,a family physician in Hershey, Pennsylvania, mailed lab results to patients. He’d also share results over the phone, or let a nurse do it on his behalf, but only after he’d reviewed the results and the patient had provided two forms of identity verification.

Gingrich has also timed blood work just before a patient’s already-scheduled visit so they can talk about results in person without having to make an additional appointment.

“Ultimately, it’s the patient’s information,” he says, “and it should be accessible to them.”

Dr. Siobahn Hruby, an internist inLittle Rock, Arkansas, says that large university hospitals often hold onto lab results for up to a week so that doctors have time to review them before they’re released. Hruby has also seen front desk staff at some clinics tell patients they have their results, but they can’t give them out.

“The main reason [office staff may refuse to hand over results] is that the person giving you the results should be able to interpret them and know what the next step is,” she says.

Some screening tests for diseases, for example, are more prone to false positives. So even if a patient receives an initial positive result, it might not mean they have the disease in question. “The only person who’s really qualified to talk to you about that is your physician,” says Hruby.

The move to patient portals

Gingrich’s office recently started giving out lab results electronically, but Gingrich would never email results. He worries about providing security without a top-notch encryption system. Instead, his office has a patient portal, which is a secure online system where patients can log in to view test results and message their doctors. Portals also serve as a central repository for lab results. Many doctor’s offices, like Gingrich’s, upload them to the portal as soon as they come in.

However, even with more doctors using patient portals to streamline communication and make practice operations more efficient, patient adoption isstill relatively low. One recent study found that portals can positively affect patient satisfaction and retention. In a 2016 case study, a family physician in North Carolina estimated his practice’s portal resulted in 10,000 fewer phone calls to his office each year.

Almost every blood test should be interpreted in relation to past blood tests, current medications and diseases, and age.

Hruby sends most test results via her practice’s portal: She writes a summary explaining what a patient’s results mean and lets them know whether she recommends follow-up care. Test results are usually posted in the portal, with Hruby’s summary, the same day they’re received or the day after. For older patients who aren’t comfortable with the technology, she still prints out letters and mails results.

In Baltimore, Laura Laing gets regular blood work done because of her hypothyroidism. She sees two doctors, at different medical centers, to manage the condition. Both use patient portals to share lab results. Before, Laing says, she only heard about results if they were abnormal. Now, results are promptly uploaded to the portal and Laing receives an email notification that they’re ready. “I love the system my doctors use,” she says. “The summaries are super easy to follow, and I’ve found myself looking through my blood work results to check each of the levels.”

Getting results on your own

You can also get results directly from a lab. Patients who register with Quest Diagnostics, for example, can access most results in the Quest system within seven to 10 days.

A 2014 federal regulation — the lab test result data access rule — guaranteed patients in all 50 states the right to access the results of tests performed by freestanding labs (as opposed to a lab in a hospital or doctor’s office). Before that, patients in some states had direct access to lab results, while other states required a doctor’s permission for direct access, and still others forbade it altogether.

Hruby and Gingrich are all for giving patients direct access. But they both have concerns that patients who see slightly abnormal test results — either in a report sent directly from a lab or in a patient portal — without any explanation from a doctor will worry unnecessarily. “People get very anxious,” Hruby says.

Doctors should let patients know how results will be conveyed, when the results will come in, and what to do if they don’t hear back in that time frame.

Almost every blood test should be interpreted in relation to past blood tests, current medications and diseases, and age, she says.A lab company can’t do that; only a physician can. “And it’s not the kind of thing you can Google,” says Hruby.

That doesn’t mean every portal does its job perfectly. A recent study found that almost two-thirds of patients who obtained test results from a portal received no explanatory information. Nearly half of those patients then conducted online searches, and many with abnormal results ended up calling their doctors. Another study found that while portals help patients participate more actively in their healthcare, they also may increase anxiety. Yet another study showed that more patients are receiving serious diagnoses over the phone, which in part could be due to doctors wanting to get ahead of patients seeing the news on a patient portal.

Still, portals do help ensure that patients receive their results, and quickly. Past studies have shown that between 8 and 26 percent of abnormal lab results were not communicated to patients promptly.

What patients are owed

The American Medical Association has general guidelines for physicians on how to communicate clinical results. Patients should get results in a “timely fashion” and doctors should be “considerate of patient concerns and anxieties.”

Doctors should let patients know how results will be conveyed, when the results will come in, and what to do if they don’t hear back in that time frame, says the AMA.

When Hruby orders a test, she always gives patients an idea of when results will be ready. “It’s a fair question to ask,” she says.

Patients should also assume that “no news is no news,” she says, and not necessarily good news. If you haven’t received results after a reasonable amount of time, follow up. “Definitely take ownership,” she says.

Donovan adds that, when it comes to getting test results, “the process should be transparent and patients should consent to it as part of the check-in process.”

Deborah Lynn Blumberg is a Houston-based freelance writer specializing in health and wellness and business and finance. Previously a reporter for Dow Jones/The Wall Street Journal, she's also written for publications including Barron’s, The Christian Science Monitor and Newsday.

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For people with irritable bowel syndrome, it’s common to hear that symptoms such as cramping, alternating diarrhea and constipation, and bloating are “all in their head.” In the case of IBS, there’s actually some truth to this.

It’s not that their symptoms don’t exist. IBS is a very real disorder, and managing its physical toll often becomes an all-consuming effort. The litany of concerns that accompany so many activities — always scouting the closest bathroom, making sure you can reach it in time, farting in public — keeps many people with IBS from having a social life.

Yet according to some experts, IBS is not solely about what’s going on in the digestive system; rather, the brain exacerbates the condition. “IBS is a disorder of brain-gut dysregulation,” explains GI psychologist Sarah Kinsinger, who is also co-chair of the psychogastroenterology section of the Rome Foundation. Accordingly, addressing the “brain” side of IBS through cognitive behavioral therapy with a trained psychologist may help decrease both the anxiety that’s often associated with the disorder and its physical symptoms.

“CBT really should be the first-line treatment for people with IBS. It’s the treatment with by far the most empirical support, and when done well, it can be curative,” says Melissa Hunt, associate director of clinical training in the psychology department at the University of Pennsylvania.

In a series of trialspublished last year, researchers in the UK compared the standard treatment for IBS (typically diet and lifestyle modifications and/or medication) with eight sessions of CBT delivered over the phone or online. Before and after the trials, participants answered questionnaires designed to measure their anxiety, depression and ability to cope with their illness. Two years after the trials, 71 percent of the phone-CBT group and 63 percent of the online-CBT group reported clinically significant changes in their IBS symptoms. Meanwhile, less than half of the standard-treatment group reported such an improvement. Those who did CBT also exhibited lower levels of anxiety and depression and higher coping ability than other participants.

In an earlier meta-analysis (a study of studies), published in 2018 in the Journal of Gastrointestinal and Liver Diseases, a different team of researchers also found that CBT appeared to reduce both psychosocial distress and the severity of IBS symptoms, with a greater effect on the physical symptoms than on the mental ones.

Explainers

The brain-gut connection

How this happens is not completely clear at this point, but it’s believed to have something to do with how the gut and brain communicate.

“IBS is thought to be a disorder of centralized pain processing,” Hunt explains. “There is miscommunication between the pain centers in the brain and the nerves in the gut. In people with IBS, pain signaling gets inappropriately amplified.” Discomfort that wouldn’t even register in the majority of people feels like being stabbed in the gut to a person with IBS. “The best way to address that is to find ways to help reduce pain signaling, and that’s with a psychologist,” Hunt says.

CBT for IBS entails learning relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, which help reduce the “volume” of the pain signals by activating the parasympathetic nervous system, i.e., the body’s “rest and digest” response. “This can also lead to increased blood flow and oxygen to the digestive system, which helps the GI tract to function in a more rhythmic way,” says Kinsinger, who is also an associate professor at Chicago’s Loyola University Medical Center.

CBT also involves thought restructuring. IBS can cause a cycle of worry: Worrying about symptoms leads to being hyperfocused on the slightest hint of any symptom, which increases anxiety, which aggravates symptoms. People with IBS also often catastrophize, meaning they assume the worst will happen (“If I have an accident at work, I’ll get fired and never get another job”), develop social anxiety and become withdrawn. CBT addresses these issues by shifting attention away from IBS symptoms and using exposure therapy to help people gradually engage in more activities outside their homes.

Additionally, using CBT, people with IBS learn to identify and change dysfunctional ways of thinking. For example, consider someone with school-aged children who asks their spouse to attend all school functions because they’re afraid of farting in a room with other parents, which would inevitably cause humiliation and might even make people think they’re disgusting A therapist might ask them how often they notice bodily noises from other people to help them realize that we’re a lot more cognizant of our own bodily functions than other people are. “In other words, we identify the catastrophic beliefs and then search for evidence supporting them or not,” Hunt says.

CBT is a skills-based, goal-oriented approach to treating mental disorders that emerged in the mid-20th century. All CBT programs share the same underlying goal of helping patients identify and modify negative or unhelpful thought patterns and behaviors. “It teaches patients techniques that they can then implement on their own.” says Kinsinger. “It can be done pretty efficiently, depending how motivated and receptive one is to learning these skills.” But over time, customized versions of CBT have been developed for specific conditions including insomnia, schizophrenia and IBS. Different versions of CBT use different techniques, such as role-playing, exposure therapy and relaxation exercises, and vary in length. On average, CBT for IBS lasts between 4 and 10 sessions in total.

Jeffrey Lackner, professor and chief of the division of behavioral medicine at the University at Buffalo, SUNY, says their program is structured like a course: “You learn a specific skill to manage your GI symptoms, process information differently or respond to stress in a less extreme way. Then you practice that skill in session before using it in the real world.” Often therapists also give patients homework to fine-tune the skills they learn. They come out of CBT with a toolbox of techniques to manage the day-to-day burden of IBS.

Some people with IBS do CBT on their own, using self-help books, online materials or apps without ever seeing a therapist. “Not many psychologists are trained to treat GI disorders specifically, so physicians don’t often have anyone to refer patients to,” Kinsinger says. The Rome Foundation trains psychologists and maintains a directory of gastrointestinal psychologists, but if someone can’t find a provider in their area, Hunt and Kinsinger recommend looking for a psychologist who’s trained in CBT and has experience treating chronic pain, panic disorders or anxiety.

Reducing sensations vs. reducing sensitivity

Not everyone is fully on board with CBT for IBS. One 2018 review study found “insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases” including IBS. A different 2018 review concluded that although psychological treatments for IBS appear to help in clinical trials, it’s unclear if they work in other settings and which treatments — such as CBT, mindfulness-based stress reduction and guided affective imagery — are most effective.

IBS is a complex problem, and some doctors prefer to integrate CBT with other treatments. But “by the time we see them,” Lackner says, “many of our patients have found that the medical treatments have not provided adequate symptom relief.”

Some IBS patients also find thetraditional approaches too hard to stick with. The most commonly prescribed treatment is a “low-FODMAP” diet, which requires giving up all dairy and legumes, plus many grains, fruits and vegetables. “Some trials show that even if the diet reduces or eliminates GI symptoms, it doesn’t improve quality of life because it’s crazy restrictive,” Lackner points out.

“With IBS, the nerve endings in the gut have become hypersensitized, and the brain magnifies those signals in the gut,” Hunt says. “The low-FODMAP diet tries to reduce the sensations, whereas CBT reduces the hypersensitivity. When you turn down the volume on the sensations, then you can eat whatever you want.”

Whether CBT helps with this brain-gut dysregulation, addresses distorted thinking and anxiety, or increases confidence in a person’s ability to manage gastrointestinal symptoms — or all of the above — it’s helped people with IBS resume parts of their life they’d put on hold.

Brittany Risher is a writer, editor and digital strategist specializing in health and lifestyle content. She's written for publications including Men's Health, Women's Health, Self and Yoga Journal.

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